Evaluation of the Interplay between HIV and COVID-19 in a large urban safety-net HIV clinic

项目摘要/摘要 一场史无前例的新冠肺炎突发公共卫生事件正在全球范围内展开， 自2020年3月26日以来，美国一直是疫情的中心。此前没有发生过全球范围内的猪流感大流行 这一规模在时间上与艾滋病毒大流行重叠。尽管如此，考虑到惊人的速度 尽管疫情有所进展，但人们对艾滋病毒和SARS-CoV-2之间的相互作用知之甚少 鉴于新冠肺炎最近才进入艾滋病毒高发区。新冠肺炎大流行是 威胁到艾滋病规划署在全球范围内取得的90：90：90艾滋病毒目标，因为它扰乱了卫生系统、经济和 艾滋病毒携带者的健康。旧金山是美国第一个实行“避难所到位”的城市。 公共卫生措施，2020年3月16日。鉴于有必要限制面对面访问以遏制病毒的传播 新冠肺炎，关于对艾滋病毒结果、护理保留和社会行为结果的影响的研究将是 制定干预措施以减轻新冠肺炎的S有害影响并为未来的大流行做好规划至关重要。 感染艾滋病毒(PWH)的人是或多或少对新冠肺炎或严重疾病易感尚不清楚； 严重新冠肺炎的一些危险因素(年龄较大、心血管疾病、肺部疾病) 在PWH中流行，但HIV药物如替诺福韦及其代谢物可以起到保护作用。PWH In 低收入人群的住房和粮食缺乏保障，增加了传播风险。考虑到影响 HIV对免疫反应的影响，同样重要的是要了解PWH对 新冠肺炎感染后。最后，新冠肺炎对S造成的医疗和社会服务中断的影响 因为无论是在危机期间还是在危机发生后，威尔斯亲王都需要紧急研究，因为新冠肺炎有可能 消除迄今在结束艾滋病毒流行方面取得的进展。 这项提议将回答有关这两种病毒之间相互作用的三个关键问题。这个 这项研究的地点将在86号病房艾滋病毒诊所，这是一家为公共保险的艾滋病毒患者提供的大型安全网诊所 在旧金山，靠近新冠肺炎疫情集中爆发的社区。AIM 1将提供 对SARS-CoV-2感染风险、流行率和临床结果如何变化的新的、迫切需要的见解 艾滋病毒状况和/或抗逆转录病毒疗法(即替诺福韦)。目标2将探索艾滋病毒感染是否会损害 对新冠肺炎的体液或T细胞反应，为治疗和疫苗开发提供见解。目标3 数据将评估医疗保健和社会支持系统中断对威斯康星医院的影响，包括病毒 压抑；保留护理；住院、共病结局和非新冠肺炎相关死亡； COVID019期间的医疗保健利用情况；以及社会距离期间和之后的社会行为结果 评估与世隔绝、食物不安全、压力、物质使用、耻辱和韧性。驾驭，研究 加州大学旧金山分校的基础设施，全市范围的新冠肺炎注册，以及由 在86号病房诊所，这笔赠款将立即进行高影响的研究，以跟踪相互冲突的流行病。

PROJECT SUMMARY/ ABSTRACT An unprecedented public health emergency due to the COVID-19 pandemic is unfolding worldwide and the United States has been the epicenter of the pandemic since March 26, 2020. No prior global pandemic of this scale has overlapped temporally with the HIV pandemic. Despite this, given the breathtaking speed at which the pandemic has progressed, very little is known about the interplay between HIV and SARS-CoV-2 given that COVID-19 has only recently entered areas of high HIV prevalence. The COVID-19 pandemic is threatening worldwide gains in UNAIDS 90:90:90 targets for HIV by disrupting health systems, economies, and the health of people with HIV. San Francisco was the first city in the U.S. to impose “shelter in place” public health measures on March 16, 2020. Given the need to limit in-person visits to counter the spread of COVID-19, research on the impact on HIV outcomes, retention in care, and sociobehavioral outcomes will be crucial to develop interventions to attenuate COVID-19's deleterious impact and to plan for future pandemics. Whether people with HIV (PWH) are more or less susceptible to COVID-19 or severe disease is unknown; some of the risk factors for severe COVID-19 (older age, cardiovascular disease, pulmonary disease) are more prevalent among PWH but HIV medications such as tenofovir and its metabolites could be protective. PWH in low-income settings have marginal housing and food insecurity, increasing transmission risk. Given the impact of HIV on immune responses, it is also important to understand if PWH will have less durable immunity against COVID-19 following infection. Finally, the impact of the COVID-19's disruption of medical and social services for PWH needs urgent study, both during the crisis and in its aftermath, since COVID-19 has the potential to eradicate the progress made on Ending the HIV Epidemic to date. This proposal will answer three vital questions concerning the interplay between the two viruses. The site of the study will be at the Ward 86 HIV Clinic, a large safety-net clinic for publicly-insured patients with HIV in San Francisco, near the neighborhoods experiencing concentrated COVID-19 epidemics. Aim 1 will provide novel, urgently needed insights into how SARS-CoV-2 infection risk, prevalence and clinical outcomes vary by HIV status and/or antiretroviral regimen (i.e. tenofovir). Aim 2 will explore whether HIV infection will impair humoral or T-cell responses to COVID-19, providing insights for therapeutic and vaccine development. Aim 3 data will evaluate the impact of disruption of healthcare and social support systems on PWH, including viral suppression; retention in care; hospitalizations, co-morbidity outcomes, and non-COVID-19 related death; healthcare utilization during COVID019; and socio-behavioral outcomes during and after social distancing to assess isolation, food insecurity, stress, substance use, stigma, and resilience. Harnessing, the research infrastructure of the UCFAR, citywide COVID-19 registries, and a large, aging population of PWH served by the Ward 86 clinic, this grant will put immediate, high-impact studies in place to track the colliding pandemics.